Latest Australian research

Parker C, Weinkove R, Wei AH, McQuilten ZK.

Purpose: Acute myeloid leukaemia (AML) carries major clinical, economic, and psychosocial burdens. Supportive care is critical to prevent mortality and morbidity and support long-term well-being. Many AML trials focus on treating AML disease, but few prospectively evaluate supportive care measures. This study sought to identify AML supportive care research priorities to inform the design of future AML clinical trials.

Methods: A three-stage online Delphi process was used. Participants (clinicians and people with lived experience) were invited from Australia and New Zealand through the Australasian Leukaemia and Lymphoma Group (ALLG), the Leukaemia Foundation, and professional networks. Round 1 generated supportive care research question, and in round 2, participants rated each question's importance. A priori criteria were applied for a question to continue to round three. Finally, participants ranked their top 10 research questions and the type of research needed to address each question.

Results: A total of 31 participants completed round one, and 22 in rounds two and three. People with lived experience made up 32% of the sample in round one, 45% in round two, and 27% in round three. Round one resulted in 66 research questions across 13 domains. In round two, from the initial 66 questions, 16 (24%) met the criteria to progress to the next round. In the final round, participants agreed on 10 priority research questions.

Conclusion: This Delphi process identified ten supportive care research priorities in AML across many domains, including infection management, bleeding prevention, nutrition, exercise, and frailty assessments. This work, which incorporates people with lived experience, can be used to inform design of future AML trials.

Tran M, Tham KY, Webster S, Troy L, Fermoyle C, Geis CM, et al.

Objectives: To facilitate earlier access to palliative care (PC) for interstitial lung disease (ILD) patients, a combined ILD-PC clinic was launched at Royal Prince Alfred Hospital. We describe referral patterns and clinical practice 16 months post-implementation.

Methods: A review of consecutive patients referred to the ILD-PC clinic was performed. Reasons for referral, PC interventions implemented and clinical outcomes were documented.

Results: 36 patients were referred to the ILD-PC clinic (75±8 years; 57% men). Diagnoses included idiopathic pulmonary fibrosis (49%), unclassifiable ILD (14%), chronic hypersensitivity pneumonitis (14%) and connective tissue disease-associated ILD (11%). Reasons for referral included high symptom burden (91%), advanced disease (66%) and disease progression (49%). PC management strategies encompassed symptom management (60%), referral to community PC services (40%), advance care planning (26%) and the prescription of opioids and benzodiazepines (23%). During the follow-up period, 23% of patients self-reported worsening symptoms, 40% demonstrated lung function decline, 11% died and 6% were listed for lung transplantation.

Conclusions: The ILD-PC clinic incorporates a multidisciplinary, patient-centred approach to ILD care by enabling early access to symptom management, community services and advance care planning.

Chow JSF, Maurya N, Jobburn K, Harlum J.

Abstract: Palliative Extended and Care at Home (PEACH) program, implemented in 2013, aimed to support palliative care clients in their last days of life at their own home. Understanding the factors that influence the sustainability of a program was vital to improving the longevity, adaptability, and quality of service delivery models. This study aimed to assess the sustainability of PEACH model of care through analysis of data at different time points where services were delivered by different service providers. Deidentified data were collected retrospectively for all consecutive patients receiving a PEACH package until separation from the package to explore the clinical and sociodemographic determinants of the sustainable PEACH model of care. Additionally, feedback on the services via survey was obtained from the clients' primary carers. The majority of the PEACH package recipients who had a clear preference to die at home when the service was initiated were able to achieve their goal to die at home (77%-84%). Eighty-six percent of the carers were "satisfied" or "very satisfied" with the overall care provided by PEACH. The result shows that PEACH model of care managed to sustain and optimize the patients' outcome despite transitioning to different service providers for partnerships and collaboration.

Ross ML, Iyer R, Williams ML, Boughey M, O'Callaghan C, Hiscock R, et al.

Importance: Psilocybin-assisted psychotherapy may offer a novel approach to treating depression, anxiety, and existential distress in individuals with life threatening illnesses, where current treatments show limited efficacy.

Objective: To evaluate the efficacy and safety of psilocybin-assisted psychotherapy versus active placebo and psychotherapy in adults with life-threatening illnesses.

Design: Double-blind, randomized controlled phase 2b trial (RCT) with an open-label extension and 6-month follow-up (January 2020 - October 2023).

Setting: Single-site study at a tertiary hospital's palliative care department (St. Vincent's Hospital Melbourne affiliated with the University of Melbourne).

Participants: Adults aged 18-80 with a life-threatening illness and clinically significant depression and/or anxiety.

Interventions: Participants were randomized to receive 25 mg psilocybin or 100 mg niacin (active placebo), alongside three preparatory psychotherapy and six post-dose integration psychotherapy sessions. After 6-7 weeks post double blind dose, all participants received 25 mg psilocybin in an open-label extension, enabling a two dose versus one dose group comparator. Participants were followed up to 26 weeks post open label dose.

Main outcomes and measures: Primary outcome was change in depression and anxiety symptoms, assessed using the Hospital Anxiety and Depression Scale (HADS), from baseline to 6-7 weeks post-dose. Key secondary outcomes included the Beck Depression Inventory-II (BDI-II) and the State-Trait Anxiety Inventory - State version (STAI-S), which provided complementary, dimensional measures of depression and anxiety over the same time period. Additional secondary outcomes included Death Attitudes Profile, WHOQOL-BREF, State-Trait Anxiety Inventory (STAI-Trait scale), Mystical Experiences Questionnaire, and Persisting Effects Questionnaire. Exploratory outcomes included spiritual well-being, hopelessness, demoralization, and HADS-Trait scores.

Results: Thirty-five participants (mean age 56.0; 54.3 % female) were randomized (psilocybin: n = 17; placebo: n = 18). At 6-7 weeks, psilocybin produced significantly greater reductions in HADS depression (B = -2.49; P = .02; d = 1.12), BDI-II (B = -7.56; P = .004; d = 2.97), and STAI-State anxiety (B = -12.59; P = .005; d = 4.51) compared to placebo. Benefits were sustained at 26 weeks. Exploratory outcomes demonstrated enhanced spiritual well-being, quality of life, and significant reductions in demoralization, death anxiety and hopelessness. No serious treatment-emergent adverse events occurred. Psilocybin was associated with more mild-to-moderate adverse events. One participant withdrew due to anxiety during dosing.

Conclusions and relevance: Psilocybin-assisted psychotherapy appears safe and may offer durable relief from

Trommer M, Gillett P, Franchini F, Trapani K, Hornby C, Abraham S, et al.

Background: Palliative radiotherapy (PRT) is crucial for improving quality of life in patients with advanced-staged cancer. This large data analysis investigates the travel distances and potential disparities in PRT access especially focusing on the burden of excess travel for palliative cancer patients in Victoria, Australia.

Methods: Using a state-wide linked dataset from the PRedicting the health economic IMPact of new and current Cancer Treatments (PRIMCAT) research program, we analysed the estimated road travel distance (ERTD) and potential excess travel distance (PETD) as well as received radiotherapy fractions for 29,807 PRT patients being treated from 2010-2019. We examined disparities by socioeconomic status (SEIFA) and remoteness (RA) of the residential area of PRT patients, and receiving treatment at a public or private centre.

Results: The average one-way ERTD for all PRT patients was 43 km, with variations based on SEIFA and RA. Patients in the lowest SEIFA quintile and those living in outer regional areas had the longest ERTD. Approximately 50% did not receive treatment at the closest facility, with a mean PETD of 27.9 km for private and 24.3 km for public facility patients. Fractionation patterns showed no significant reduction in the number of fractions with increased travel distance. Patients at private facilities received more fractions on average (8.49) compared to those at public facilities (5.91).

Conclusion: This study highlights potential disparities in PRT access in Victoria, with patients living in socioeconomically disadvantaged and remote regions facing longer travel distances and excess travel. These findings underscore the need for strategic referral practices and further research to optimise equitable access to PRT.